Week 1: Where Did Digital Health Come From?

MOOC Summaries - Medicine in the Digital Age - Digital Health

Week 1: Where Did Digital Health Come From?

“Technology Revolutions… Where Did Digital Health Come From… Understanding Social Networks… The Internet and the Digital Revolution.. mHealth and the Mobile Revolution… Informed Patients.. The Internet and Patients… The E-Patient…”


  • Technology Revolutions > Understanding Social Networks
  • Technology Revolutions > The Internet and the Digital Revolution
  • Technology Revolutions > mHealth and the ‘Mobile Revolution’
  • Informed Patients > The Internet and Patients
  • Informed Patients > The E-Patient

Week 1: Where Did Digital Health Come From? > Technology Revolutions > Understanding Social Networks

  • Social networks play a huge role in shaping new opportunities in digital health, through peer-to-peer collaboration and through many other means.
  • There are three major changes that laid the foundation for digital health:
    • social network revolution;
    • internet revolution;
    • mobile revolution.
  • Drawing on Lee Rainie and Barry Wellman’s book Networked– The New Social Operating System.
  • Social networks- focus on relationships between people, not so much on individual participants.
  • E-patients with rare disease – other members of their social network who share their condition may be far more important than anyone they met in person.
  • Three key areas of change in digital social networks:
    • widespread connectivity;
    • weaker group boundaries;
    • increased personal autonomy.
  • At the same time that we see increased connectivity, we also see increased personal autonomy e.g. more people in the U.S. are doing flexible, creative work instead of factory-based manufacturing jobs.
  • Rainie and Wellman: digital social networks can connect people and also overload them.
  • Rainie and Wellman also point out that the networked operating system offers new ways to solve problems and meet social needs, but it also requires new strategies and skills.
  • There are also many more opportunities- and stresses- to reach beyond tight groups, and there are many questions about such networked relationships e.g. how are they interconnected? cleavages? central vs peripheral? how permeable are the boundaries?

Week 1: Where Did Digital Health Come From? > Technology Revolutions > The Internet and the Digital Revolution

  • Diffusion of innovations theory: new technologies reach market saturation by moving sequentially through groups, starting with early adopters and ending with laggards.
  • For various reasons, not all technologies follow this.
  • Technological determinism: the way technologies are designed completely determines how people use those technologies.
  • A key problem with this: it ignores the fact that technologies are developed by people, and people live within cultural contexts; hence technologies are imbued with cultural values from the beginning.
  • This fundamental concept means that that technologies such as the internet, smart phones, or self-tracking devices, do not simply emerge when the moment is right. The result from deliberate choices, advantageous circumstances, and a complex mix of both intended and unintended consequences.
  • To understand why a new technology is widely adopted, look for what attracted the end users. For example, for the Internet, it was
    • minimal federal regulation;
    • rapid improvements in cost usability (due to Moore’s Law);
    • rapid expansion of bandwidth;
    • improvements to radio spectrum;
    • compatible interconnected networks;
    • flat rate access fees;
    • huge improvements in data storage cost and capacity;
    • appealing apps such as email etc.
  • Affordances: features that allow users to do something specific with a technology or a design i.e. “the possible actions a person can perform on an object.” For example, for the personal computer and the internet:
    • personal;
    • connected people;
    • helped people more than intimidate;
    • provided customized and private communication;
    • decentralized and open to individual choice;
    • allowed for asynchronous communication;
    • access to information.
  • We can thus examine the internet or digital health innovations through the idea of affordances e.g. what a user gets out of using the technology and design, and if that matches the intended result.
  • Digital divide (pertinent to digital health too):
    • Conventionally, based on socioeconomic status i.e. those who access to computers, or later broadband versus those who did not.
    • Now, it includes  differences in skilled use of these technologies, and these differences can worsen social inequalities; income and education are leading indicators too.

Week 1: Where Did Digital Health Come From? > Technology Revolutions > mHealth and the ‘Mobile Revolution’

  • With the mobile revolution, information and communication technology are now like parts of our body, allowing us to access contacts and information wherever we are whenever we want.
  • Mobile revolution has given rise to mHealth (mobile health), which is about the use of mobile phones and other connected devices to improve health.
  • This field is rapidly growing and has reached a stage where the validity and the efficacy of some innovations have been tested through randomized controlled trials (but some are asking if it is the best way to assess these innovations).
  • Some interventions e.g. texting for prenatal care, smoking cessation, and weight loss, have been studied fairly rigorously,
  • There are differences worldwide in adoption and use of mobile/smart phones; as a result, there are also differences in innovation and regulation in different countries e.g. between low and middle income countries than in the highest income countries.
  • The locus of control has shifted from the top down, one way broadcast model to the bottom up, two way, or really many to many social connection model.
    • Usability and engagement are important but there are also other considerations e.g. users have more control over when and how we can contact them and when and how they choose to engage.
    • There are also consideration about users’ sense of space, time, presence, social connectedness, availability, and findability.
    • Everyone may use mobile media, but not everyone uses it in the same way.
  • We should also not assume that the digital answer is always the right answer; the best answer can sometimes be analog (depending on the users).
  • A mobile digital divide exists but it is quite complex e.g. Pew Research shows that more low income users access health information online through their mobile phones than through desktop computers, but divisions exist along lines of race and ethnicity, income, and educational attainment, and age.

Week 1: Where Did Digital Health Come From? > Informed Patients > The Internet and Patients

  • Patients/consumers are increasing getting more and more information from their networks.
  • We now have the self-diagnoser:
    • 35% of Americans have gone online to figure out a health problem, and of those 36% discover they needed the help of a professional while 38% found that they could take care of the problem themselves.
  • Numbers are even higher amongst those with chronic conditions – close to 60%.
  • Information is also finding patients through their social networks rather than the other way around.
  • Note: not everyone has access to the internet and disparities remain an issue.

Week 1: Where Did Digital Health Come From? > Informed Patients > The E-Patient

  • The relationship between doctor and patient is changing: there is a new kind of patient, the e-Patient.
  • An e-Patient is a health consumer who participates fully in his or her medical care:
    • they find online information about their condition;
    • they have the skills to manage their own condition;
    • they make choices about self-care;
    • they are equals in their partnership with the physician.
  • The availability of information has given the patient power, wisdom, and confidence, and a formerly paternalistic relationship between doctor and patient has become more equal and balanced.
  • Sherry Turkle from MIT:
    • “The key question is ‘not what technology will be like in the future, but what we will be like in the future,’ when we have learned to live and work appropriately within the new technocultural environments even now being created by our new technologies.”
  • There are clear advantages that to being empowered patient, new responsibilities and also downsides.

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photo: depositphotos/cienpies
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